Chicago Tribune's Cultural Critic, Julia Keller, Reviews County

A doctor's view of Cook County Hospital — and our medical mess

Julia Keller CULTURAL CRITIC

9:32 a.m. CDT, July 22, 2011

Forget politics. Just for a moment, assume politics doesn't exist in the United States. Pretend there is no such thing as Democrats, Republicans, independents, Libertarians, members of the Green Party or the tea party. Or even the Green Tea Party. No liberals. No conservatives.

In this pure realm, this place of suffering people on one side, and on the other side, the professionals — nurses, doctors and support staff — who possess the expertise and the equipment and the pharmaceuticals to alleviate that suffering, there is no argument, no dilemma, no hesitation, no gray area.

If politics suddenly didn't exist, if we didn't fight all the livelong day over who gets what, if we weren't so obsessed with elections and power and money, then things would be very simple:

If you get sick, you go to a place where people try to make you feel better. Period.

Yet as David A. Ansell chronicles in his heartbreaking and important new book, "County: Life, Death and Politics at Chicago's Public Hospital" (Academy Chicago), that basic, uncomplicated idea — that ailing people ought to be helped, no matter who they are or where they live or whether they had the means and the prescience to buy health insurance — is wishful thinking. Politics is alive and well in the world of American medicine.

These days, Ansell is a suit-and-tie guy, the buttoned-down chief medical officer and vice president of clinical affairs at Rush University Medical Center. In 1978, however, as he recalls in "County," he was a corduroy-and-Rockports kind of guy, an energetic, idealistic, bushy-haired young intern fresh out of medical school, joining his like-minded friends as they marched through the doors of Chicago's legendaryCook County Hospital — founded more than a century and a half ago, making it one of the nation's most venerable public hospitals — with vigor and optimism:

"We did not come to County Hospital just to learn to be doctors," Ansell writes. "We came to County because we believed that health care was a right, not a privilege." County, he knew, "was at the front lines of this battle." It was a place of "inept management; underfunding; a corrupt political Machine," a place in which "patients were dumped and refused care at other hospitals." Patients "died at our doorstep or on our watches."

Ansell's book is half memoir and half manifesto. While telling the story of his own professional coming-of-age at County, a story that is as quirky, funny and dramatic as an episode of "ER," the popular NBC series (1994 to 2009) that was based on life at County, Ansell lays the groundwork for his unwavering conviction that "the inhumanity of health insurance still persists." He has seen how the current system works — or, more accurately, doesn't work, leaving scores of poor people with inadequate care or no care at all.

"County" is a bold, principled argument on behalf of a single-payer health care system "that provides equal access to all residents regardless of income, race or ethnicity," Ansell writes. "Without it we will never succeed at achieving health equity — fairness, equality and dignity for all patients — in Chicago or the U.S."

Ansell ended up spending 17 years at County. He describes the people — mostly poor, black and powerless — he treated, year after year, in the rambling, antiquated structure with no air conditioning and open wards, without proper equipment. County was closed in 2002, replaced by John H. Stroger Jr. Hospital, but the name "County" is still synonymous with the nation's shamefully bifurcated health care delivery system.

"County" is written with a kind of lilting rage. Not the dark, destructive kind of rage that hurls rocks and obscenities at anything in its path, but an uplifting and creative rage. A rage that says, "We can do better than this." A rage that steadily pushes its way toward hope.

The book has its weak points. Readers will long for an index, in order to check the sources of Ansell's information. And he has a propensity for generalities and platitudes that tends to blunt the force of his otherwise sharp, specific observations. Cliches often bedevil his prose; demands for change at County "reached full throttle but fell on deaf ears …" and his internship was "white-knuckle scary," to note just a few.

But these are quibbles. "County" is a landmark book, brave and angry and indispensable, not least because Ansell dares to declare that the health reform legislation passed in 2010 — dubbed "Obamacare" — was no breakthrough. It "preserved the caste system of health care in America, one that all but guarantees different health outcomes depending on the patient's health insurance status."

As Ansell makes abundantly and tragically clear, it was politics, not patient care, that won the day in Washington. Again.